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Kathy,
We punt to CT, with immediate call to ENT.  Slightest sign of neuro changes we move to LP.  As a point of note, we've seen quite a bit of Pseudomonas, MRSA, and one case of venous cavernous sinosus thrombosis out our way.  In regards to MRSA, noting kids getting their ear tubes contaminated, which precipitates removal... Then you find out they've been sitting in school for a week or so with goo dripping out the ear, onto the shirt, on their hands/desk/whatever.
Jim Wilson, MD
Pediatrics
Delta CO

On Jun 1, 2012, at 11:20 AM, Mohammed <[log in to unmask]> wrote:

> The prolonged hx while on antibiotics is worrisome.
> Our colleagues ENT definitely will ask for CT
> Best Regards
> 
> M Alomar
> Riyadh, Saudi Arabia
> 
> On Jun 1, 2012, at 5:29 PM, neil mullen <[log in to unmask]> wrote:
> 
>> DDX exists.  Image.
>> 
>> 
>> 
>> ________________________________
>> From: "Goetz, Kathleen" <[log in to unmask]>
>> To: [log in to unmask] 
>> Sent: Friday, June 1, 2012 12:19 AM
>> Subject: mastoiditis imaging
>> 
>> 9 month old healthy immunized child with 17 days OM.  Treated with Amoxil x 7 days, cefdinir x 10 days, presents with protruding right ear, suppurative ROM, post auricular erythema, fever, otherwise well appearing.  
>> Would you image this child who has clinical mastoiditis?
>> If so - CT?
>> Has your practice changed due to increasing concerns about CT/radiation exposure in infants?
>> Kathey Goetz
>> 
>> Kathleen Goetz, MD
>> Medical Director
>> Swedish Pediatric Emergency Services
>> Office:  206-386-3313  ED:  206-386-2573  Cell: 253-370-7571
>> 
>> 
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
>> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
>> The URL for the PED-EM-L Web Page is:
>>                http://listserv.brown.edu/ped-em-l.html
>> 
> 
> For more information, send mail to [log in to unmask] with the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
>                 http://listserv.brown.edu/ped-em-l.html

For more information, send mail to [log in to unmask] with the message: info PED-EM-L
The URL for the PED-EM-L Web Page is:
                 http://listserv.brown.edu/ped-em-l.html